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The Surgery Journey

 

Should I Consider Joint Surgery? (Step 1)

Before considering surgery, there are a number of other treatment options available for osteoarthritis (OA), including physiotherapy, exercise and weight management, as well as medication. However, if you’ve exhausted other options and are still seeking relief, you may be wondering if surgery is right for you. This resource will help you talk to your doctor about when surgery might be appropriate as well as the risks and benefits involved.

  • 1. Am I Ready for Joint Surgery?

    If significant OA is present, choosing to have surgery is likely to depend on your level of pain and how restricted you are in your daily activities.  Ask yourself:

    • Do you need help to complete daily tasks because of your osteoarthritis?
    • Does your pain keep you up at night despite using medication and other sleep aids?
    • Has your pain gotten worse lately?
    • Have you exhausted all other non-surgical treatment options?
    • Is it too difficult to get up from a chair or climb stairs?
    • Does your doctor say other treatment options won’t be effective?
    • Do you find it difficult to deal with the side effects of your medication?
    • Are you committed to the pre- and post-surgical therapies required?

    If you answered “Yes” to all of the above questions, it might be time to talk to your doctor about surgery.  If you answered “No” to any of the questions, surgery might still be an option, but there are other factors to consider.

  • 2. When is Surgery Not Appropriate?

    If your pain isn’t limiting your normal activities, if you can get relief from medications or therapy, or if you can still do things like walking and shopping, surgery may not be necessary. Surgery is also not appropriate for patients who want to return to high-impact sports such as running.

    On the other hand, waiting until you’ve already lost a lot of your strength, flexibility, and ability to perform daily tasks can make it more difficult to return to your normal activities after surgery. “Surgery is best done when your pain is limiting, but not disabling and when your function is limited, but you are still capable of improvement” (”When is hip surgery necessary?” Sunnybrook Hospital, 2018).

    Doctors may not recommend surgery for people who have:

    • Poor general health
    • Active infection or are at high risk of developing an infection (e.g. patients who are smokers, have uncontrolled diabetes, are immunocompromised, or who are very obese and have not attempted weight-loss)
    • Severe muscle weakness that would make it difficult for muscles to support the new joint  
  • 3. What are the Potential Benefits and Risks?

    Benefits can include:

    • Reduced pain
    • Improved ability to stand, walk and/or move
    • Increased ability to do daily activities 
    • Return to low-impact recreational activities (e.g. swimming, cycling, golf)
    • Joint could last a lifetime with proper weight management, joint protection and regular exercise/activity

    Risks can include:

    • Ongoing pain in the affected joint
    • Premature wearing of the new joint and the need for a revision
    • Post surgical complications including blood clots, infection, fracture, bleeding, nerve injury, limp, joint stiffness, wound healing problems
    • Loosening of implant that makes revision surgery necessary
  • 4. What’s Next?

    Surgery isn’t for everyone – it’s always up to what you decide in discussion with your doctor. Consider everything surgery will involve, including preparation and rehabilitation. You need to be an active participant in your recovery and have patience in the process. You can also consider getting a second opinion before making the decision.

    If you think you’re ready for surgery, make an action plan with your physician. Discuss which implants to use, the surgery process, the risks to be aware of and your plan for recovery and rehabilitation. Planning in advance will make for a smoother recovery and likely a better outcome.

Access the PDF

Sources

This information was reviewed in June 2019 with expert advice from:

Dr. Sarah Ward, MD, FRCSC | Orthopaedic Surgeon, St. Michael’s Hospital
Assistant Professor, Department of Surgery, University of Toronto

Véronique Routhier, Physiotherapist | Hôpital Montfort

Preparing for Surgery Checklist (Step 2)

If you have your surgery date booked, use this checklist to help ensure you’re ready in the months and weeks leading up to your surgery. If you’re waiting for your surgery confirmation, there’s still plenty you can do to be prepared when the day arrives.

  • In the months before surgery
    • Learn as much as you can about the surgery and what will happen during recovery and rehabilitation.
    • Practice with any mobility devices you’ll be using after surgery.
    • Eat a nutritious, well-balanced diet – stay hydrated, eat more fibre and foods high in Vitamin C, calcium, and iron.
    • Be as fit as possible to help you recover quickly.
    • Perform exercises to help strengthen your joints and reduce muscle soreness and fatigue that might result from the use mobility devices.
    • For hip or knee surgery, strengthen your leg muscles by walking regularly.
    • Complete any recommended pre-operative (pre-op) exercises twice a day .
    • Quit smoking – smoking increases your risk of getting a serious infection after surgery. 
    • Reduce alcohol use – You should not exceed 14 drinks per week (men) or seven drinks per week (women).
    • Ensure you are up-to-date on vaccinations (such as the flu vaccine).
    • Bring a friend or family member to your pre-op meeting with the surgeon.
  • In the weeks before surgery
    • Arrange for meals during your recovery period (e.g. freeze meals that can easily be reheated during the first week or two after surgery).
    • Avoid shaving for 5 days before and 2 weeks after surgery to avoid small cuts in the skin that can harbor bacteria and lead to infection.
    •  Attend any pre-operative teaching sessions arranged by your surgeon/hospital and follow the instructions. For example, you may need to contact a clinic to schedule your post-operative physiotherapy sessions once you know your surgical date.
    •  Attend any required pre-op appointments and tests (blood tests, cardiogram, x-ray).
    • The surgical team may advise you to stop certain medications (e.g. nonsteroidal anti-inflammatory drugs, blood thinners, medications used to treat rheumatologic conditions, etc.) prior to surgery. If you have questions about any of your medications, ask your surgeon.
    • If you are taking opioid pain medications, your doctor may advised that you reduce the dose as much as possible or slowly discontinue use before surgery. Patients who are taking these medications before surgery tend to have more trouble managing their pain after surgery. 
    • You will be advised to stop taking most supplements, such as multi-vitamins (check with your surgeon).
    • Remind family and friends of the date of the surgery so they can support if needed.
    • Set up your home so that you can sleep on the same floor you spend most of your day – this will help avoid the use of stairs after your surgery.
    • Move furniture, rugs and mats to avoid tripping.
    • If needed, install a raised toilet seat and/or get a bedside commode (a chair with built-in bed pan).
    • Add a small sitting stool for the shower and a non-skid mat for your bathtub or shower.
    • Move items you’ll use often to an easy-to-access location.
    • Plan how you’ll get the mail, handle laundry, prepare meals, etc. after your operation.
    • Arrange for family and friends to look after any pets and/or plants during surgery and recovery.
    • Use armchairs during recovery to support you when you sit down and stand up.
    • Arrange your bed so that the height of the mattress isn’t too low or too high.
    • Have a dental evaluation and address any dental issues before surgery.
    • Report any illness leading up to surgery to your surgeon. You should also tell your surgeon if you have any open sores on your body. If you have an infection elsewhere in your body, your surgery may need to be delayed to reduce the risk of developing a serious infection in the new joint. 
  • Packing your hospital bag: What to include
    • A list of all your current medications.
    • Your health card.
    • The name, phone number and address of your pharmacy.
    • An up-to-date contact list of family, friends, and your family doctor for caregivers and your healthcare team.
    • The names of other healthcare professionals involved in your arthritis care, along with their addresses, phone and fax numbers.
    • An up-to-date list of medication allergies, dietary restrictions and food allergies.
    • Loose, comfortable clothes to wear in hospital and for the trip home.
    • Supportive shoes that you can easily slip into.
    • If you wear glasses, contact lenses, a hearing aid or dentures, be sure to bring a case to put them in, labelled with your name and phone number.
    • Personal hygiene items such as a toothbrush, shampoo, soap, deodorant, wet wipes, and a razor (no shaving of the incision area for at least 2 weeks after the operation).
  • 24-hours before surgery
    • Take a shower/bath the night before, wash thoroughly with anti-bacterial soap.
    • Avoid lotions, powders, shaving.
    • Sleep in clean pajamas on freshly laundered sheets the night before surgery.
    • Remove any make-up, lipstick, and/or nail polish before going to hospital.
    • On the morning of surgery, you can have clear fluids (such as apple juice, sports drinks, etc.) up to 3 hours before surgery to help you stay hydrated.
    • Be sure your hospital bag is packed and ready to go.

Access the PDF

Sources

This information was reviewed in June 2019 with expert advice from:

Dr. Sarah Ward, MD, FRCSC | Orthopaedic Surgeon, St. Michael’s Hospital
Assistant Professor, Department of Surgery, University of Toronto

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